Tuesday, September 30, 2014

Q: TandemHeart can provide Cardiac Index up to what level?Answer: Cardiac index of 2.62 L/min/m2The pump flow rate ranged from 1.5 to 3.5 L/min, which resulted in an average cardiac index of 2.62 L/min/m2. IABP flow rates are limited to approximately 1.5 L/min. TandemHeart can provide up to 4 L/min. The higher level of support provided by the TandemHeart results in better hemodynamics and metabolic parameters, although it may not improve the survival rate.

Monday, September 29, 2014

Q: What are the three levels of BPF (Broncho-pleural Fistula)?

Answer:

The severity of the air leak is generally measured into 3 levels from least to most severe:

●Bubbling during inspiration only●Bubbling during both inspiration and expiration●Bubbling during both inspiration and expiration, as well as a detectable difference in the inspired and expired tidal volumes

The last category suggests that there is an air leak greater than 100 to 150 mL per breath.

Friday, September 26, 2014

Q:Risk of re-feeding syndrome increases after how many days of NPO
status or poor intake?

Answer: 5
days

It is not uncommon in ICUs for
patients to go without feed for few days. It is important to understand that any
patient who has had negligible nutrient intake for more than 5 consecutive days
is at risk of refeeding syndrome. And, refeeding syndrome usually occurs within
four days of starting to feed.

Thursday, September 25, 2014

Q:Which one electrolyte should be replaced with Thiamine infusion in
Wernicke's encephalopathy?

Answer: Mg

Magnesium is a co-factor in many
thiamine dependent enzymes involved in carbohydrate metabolism. Thaimine may not
work in the presence of low magnesium. This is clinically an extremely important
point as alcoholics usually lack magnesium.

Wednesday, September 24, 2014

In acute alcohol intoxication, a leakage of proteins from damaged hepatic cells may cause a rise in the prealbumin level. Consequently, alcoholics may have elevated levels of prealbumin after binge drinking. It takes about 7 days when levels return to baseline. Also, serum prealbumin levels may rise during prednisone/steroid therapy.

Friday, September 19, 2014

Q: What is dose dumping?Answer:Dose dumping is a phenomenon of drug metabolism in which environmental factors causes the premature and mostly exaggerated release of a drug, causing particular drug toxicity. Most common reason of drug dumping is taking fatty meals with a particular drug that increases drug delivery. It is mostly described with extended release forms of drug. Various explanations have been given including breakdown of drug's capsule or stimulation of the body's absorptive surfaces to increase the drug uptake.Alcohol is another major factor which may cause drug dumping syndrome.

Wednesday, September 17, 2014

Q: 72 year old
male, nursing home resident, admitted to ICU for Pneumonia and getting treated
with Linezolid start having fever, agitation and myoclonus which is more
pronounced in the lower limbs than in the upper limbs. What is your
concern?

Answer:Serotonin
Syndrome

One of the clinical diagnostic clue of
Serotonin Syndrome is hyperreflexia and clonus more prononuced in the lower
extremities than upper, at least in the moderate cases.

Sunday, September 14, 2014

Q: What is the cutoff point for the thickening of the gallbladder in acalculous cholecystitis on ultrasound?Answer: 3 to 3.5 mmUltrasound is preferable in patients suspected of having acalculous cholecystitis as it is noninvasive, can be done at the bedside, and has good sensitivity and specificity. Thickening of the gallbladder wall is the most reliable feature seen in patients with acalculous cholecystitis. Using a cutoff of 3.5 mm, ultrasonography has a sensitivity of 80 percent and a specificity of 99 percent for detecting acalculous cholecystitis. If a cutoff of 3 mm is used, the sensitivity is 100 percent with a specificity of 90 percent.

Friday, September 12, 2014

Q:Name at least 3 commonly used drugs
in ICU - which should not be infuse via same infusion/port line as furosemide
infusion?Answer:

labetalol

ciprofloxacin

milrinone

Furosemide drip is usually prepared in the weakly alkaline to neutral range. Above drugs are usually prepared in acid solutions. They must not be administered concurrently in the same infusion because they may cause precipitation of the furosemide. Also, furosemide injection should not be added to a running intravenous line containing any of these acidic products.

Thursday, September 11, 2014

Q: Indomethacin is one of the NSAID
which is used in nephrogenic DI (Diabetes Insipidus). What is the mehansim of
action?Answer:NSAIDs are used as an adjuvant
treatment in DI. NSAIDs may act by inhibiting prostaglandin synthesis in
Diabetes Insipidus. Inhibition of prostaglandin synthesis reduces the delivery
of solute to distal tubules, reducing urine volume and increasing urine
osmolality.

Wednesday, September 10, 2014

Q: How Desmopressin is different from
Vasopressin?Answer:Desmopressin,
1-deamino-8-O-arginine-vasopressin (DDAVP) is a synthetic analogue of arginine
vasopressin. It has 10 times the antidiuretic action of vasopressin, but 1500
times less vasoconstrictor action. These modifications make metabolism slower
with half-life of 158 min.

Tuesday, September 9, 2014

Q:What different options are available, in case patient develops
life-threatening bleeding as a complication of fibrinolytic therapy?Answer:If a patient treated with fibrinolytic develops
serious bleeding, the first step is to stop the fibrinolytic agent and any
anticoagulants. Hemodynamic stability with volume and pressors as suppoprtive
therapy is vital.Aminocaproic
acid:Aminocaproic acid is a specific antidote
to fibrinolytic agents. Loading dose is 4-5 g of aminocaproic acid over one
hour, followed by a continuing infusion at the rate of 1 g / hour. Infusion is
continued for about 8 hours or until the bleeding situation has been controlled.
Aminocaproic acid should not be given unless hemorrhage is life-threatening,
because it inhibits intrinsic fibrinolytic activity.Blood
products: FFP, cryoprecipitate, or both may be
used to replenish fibrin and clotting factors.

Monday, September 8, 2014

Q:How you define trophic enteral feeding?Answer:Trophic feeding is a small volume of balanced enteral nutrition insufficient for the patient's nutritional needs but produce positive gastrointestinal and some systemic benefit. If less than 25% of the patient's nutritional needs are administered enterally, the feeding is considered trophic. The commonly identified benefits of trophic feeding are improved feeding tolerance, maintenance of intestinal function, and prevention of intestinal bacterial overgrowth and bacterial translocation.

Friday, September 5, 2014

Q:What is Platypnea-orthodeoxia?

Answer:Platypnea-orthodeoxia is a clinical syndrome characterized
by dyspnea and deoxygenation accompanying a change to a sitting or standing from
a recumbent position.Two conditions must coexist to cause
platypnea-orthodeoxia:an anatomical
component - in the form of an interatrial communication such as PFO
or ASD anda functional
component - that produces a deformity in the atrial septum and
results in a redirection of shunt flow with the assumption of an upright
posture. This includes pericardial effusion, constrictive pericarditis,
emphysema, pneumonectomy, cirrhosis, ileus, aortic aneurysm
etc.Standing upright could stretch the interatrial
communication, allowing more streaming of venous blood from inferior vena cava
through the defect. This redirection of flow caused by an anatomic distortion of
the right atrium or the atrial septum get clinically enhanced by functional
component present.Reference:Cheng TO. - Platypnea-orthodeoxia syndrome: etiology,
differential diagnosis, and management. Cathet Cardiovasc Interv. 1999; 47:
64–66..

Wednesday, September 3, 2014

Q:52 year old male is admitted to ICU as "Pre-op" CABG patient.
Previous admission record showed patient with diagnosis of HIT (Heparin Induced
Thrombocytopenia) 2 years ago. You rechicked HIT test and OD (optimal density)
for HIT is reported as 0.2. What would be your advise on use of
Heparin?Answer:Patients with previous
history of HIT but now with negative antibodies can have heparin during CBP but
it should be avoided pre or post surgery.References:1. Follis F, Schmidt CA. Cardiopulmonary bypass in patients with
heparin-induced thrombocytopenia and thrombosis. Ann Thorac Surg.
2000;70:2173-2181.2. Warkentein TE. Heparin-induced thrombocytopenia:
pathogenesis, frequency, avoidance and management. Drug Safety.
1997;17:325-341.

Tuesday, September 2, 2014

Q:What is the most common cause of "false-negative" D-Dimer test?Answer: inappropriate collection of specimenD-Dimer test may give "false-negative" result if the specimen collection tube is not sufficiently filled (undefiled). This is due to the dilutional effect of the anticoagulant. The blood should be collected in a 9:1 blood to anticoagulant ratio, in specimen tube.